While much of Europe is in lockdown, Sweden has put its faith in the ability of its citizens to act responsibly in the face of the coronavirus pandemic. The strategy is highly controversial.
In late January a woman in her twenties in the city of Jönköping, southern Sweden, developed a cough. She had landed in Sweden a few days earlier after visiting Wuhan in China. On 31 January she became the first person in Sweden to be diagnosed with coronavirus.
Two months later, life in Sweden, like everywhere else, has been transformed. Offices have emptied, parties have been cancelled, the economy is in free fall and people wait nervously every afternoon for the daily death toll. At the time of writing, 477 people in the country of ten million have died of the disease.
Yet to British eyes, life in Sweden might seem strangely normal. Public gatherings of more than 50 are banned, but restaurants, bars, shops and even gyms are open. People are asked to work from home if possible, avoid unnecessary journeys and to keep a distance from people in public, but there are no penalties for those who ignore this advice.
The terraces of bars and restaurants in the central Odenplan district of Stockholm were packed on Saturday (4 April) with people enjoying the spring sunshine, despite the capital being the worst affected part of Sweden. My phone buzzed with messages from friends, some suggesting dinner to support a local restaurant, others frantic with worry that people they knew weren’t taking the virus seriously.
Sweden’s strategy has been led by the Public Health Agency and its professorial state epidemiologist, Anders Tegnell, who has become an instant celebrity. Prime Minister Stefan Löfven and his Social Democratic-Green government have consistently deferred to Tegnell’s judgement.
Tegnell denies that his main aim is “herd immunity”, insisting that he wants to flatten the coronavirus curve to ensure Sweden’s health service copes. The country’s softer approach, Tegnell says, is predicated on the need for public acceptance. If you put strict measures in place too early, he says, people will stop cooperating:
“Is the best motivation, ‘If I do this my parents won’t get ill’? Or is the best motivation a threat?” he asked during an appearance on the country’s most popular talk show. Tegnell is wagering that Sweden’s consensus culture will lead the whole country to voluntarily, and simultaneously, change its behaviour to protect the vulnerable. In that sense, it’s a very Swedish strategy.
So far, Swedes seem to have faith in the strategy: 77 per cent of people say they have confidence in the Public Health Agency according to opinion pollster Kantar Sifo, up from 65 per cent in mid-March. Confidence in Löfven, at a low ebb before the crisis, has since increased by 21 points to 47 per cent.
But some fear the authorities are being naive. One vocal critic of Sweden’s handling of the crisis is Björn Olsen, professor of infectious medicine at Uppsala University. Olsen warned in January that Covid-19 would become a pandemic, at a time when the Public Health Agency was saying the risk of that was low. He is scathing about the decision not to implement a full lockdown:
“You can’t just appeal to people’s consciences and say that we all need to think about this, that or the other. We’re still a bunch of individualists and people are still gathering in groups. Ban that – now – and close down as much as possible,” he told website Kvartal.
So who is right? There’s hard evidence that Swedes have acted on official advice: data from Google shows that footfall in Stockholm’s department stores, restaurants and museums is down by about a quarter. Use of public transport has nearly halved. The effect of this on businesses has been instant: some of the city’s most well-known restaurants have already gone into administration.
Hospitals in Stockholm are coping so far, with 37 unoccupied intensive care beds at the time of writing. Comparisons with Norway and Denmark, which have implemented lockdowns, are inconclusive: Sweden has a higher death toll than both its neighbours, in absolute terms and per capita. Yet Sweden’s doubling rate – the time it takes for the number of confirmed deaths to double – is six days. That’s the same as Norway and Denmark (it is five days in the UK).
Tegnell is optimistic that the measures Sweden has taken are working. In the absence of widespread coronavirus testing, steep falls in cases of the winter vomiting bug (caused by calicivirus) and seasonal influenza are being taken as signs that people are socially distancing and practicing better hand hygiene.
“All countries are trying to do the same thing,” he says. “We’re trying to get it to spread as slowly as possible. You won’t find anyone in the world who works with this kind of thing who thinks you can eradicate the disease.”
Yet Sweden is at a crossroads. While still hopeful that voluntary measures might work, on 6 April the government proposed a bill to give itself additional powers, which could involve limiting public gatherings or closing businesses without first receiving the approval of parliament.
Ultimately, the test for Sweden will not be whether the country is spared by the virus – it’s too late for that – but whether it fares any worse than its neighbours. Tegnell suspects that it won’t: “I think that most countries that get widespread infections will end up at roughly the same level.” It may be many months before we know the truth.
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